Blacks with liver cancer get fewer transplants

NEW YORK (Reuters Health) - African Americans with liver cancer are less likely than whites to get a transplant for the disease, according to U.S. researchers.

And that gap hasn’t changed in a decade, they report in the journal Cancer.

“This treatment is expensive, high tech and on the rise -- just the kind of perfect storm that leads to a disparity in care,” said study researcher Dr. Anthony Robbins of the American Cancer Society, who called liver transplants “a new lease on life.”

Liver cancer is a brutal disease, leaving just one in seven Americans alive five years after it has been diagnosed.

About one in 100 men in the U.S. develop the cancer at some point, while women are less than half as likely to do so, according to the American Cancer Society.

For the new study, Robbins and his colleagues tapped into U.S. hospital records on more than 7,700 liver cancer patients diagnosed between 1998 and 2007.

All of the patients in the study had the most common form of the disease, known as hepatocellular carcinoma, which affects 80% of all liver cancer patients. According the U.S. Centers for Disease Control and Prevention, the liver infections hepatitis B and C are behind most cases of this type of cancer.

The researchers found that over the first half of the study, white liver cancer patients had a 30 percent chance of receiving a new liver, compared to only 15 percent for blacks.

While the chances climbed somewhat during the next five years, the disparities remained. Taking into account if how soon the patients died -- some might have died before they could get a new liver, for instance -- blacks were 36 percent less likely than whites to undergo the surgery.

They were also 36 percent more likely to die within five years of their diagnosis. Once blacks got on a waiting list for a transplant, however, the gap closed and they face the same survival odds as whites.

Robbins said the medical community has known for years about the inequity in care between blacks and whites.

“After an intense effort to try to fix things and lots of thought and sensitivity to this issue, the disparity hasn’t gone away,” he said.

Although there are probably several reasons for the disparity, Robbins added, “the biggest driver is the difference in access to care at the early stages of the disease due to health insurance. And that needs to change.”

The average cost of surgery plus first year medical bills amounts to nearly $450,000.

The study also compared Asians and Hispanics to whites.

There was little difference in the number of liver transplants between whites and Hispanics. Asians had only a 19 percent chance of getting a new liver in the first half of the study, and a 24 percent chance in the following five years.

While that was much lower than whites, their disease tended to be less devastating and likely did not require a transplant in the first place, the researchers say.

Dr. Andre Dick, a transplant surgeon at Seattle Children’s Hospital who was not involved in the study, said the new research is important.

“This makes people aware that it’s getting to that waiting list that’s important and that’s where the real disparities are still showing up,” he told Reuters Health. “And how the question is, how do we overcome them?”